Spinal manipulation is a hands-on therapeutic approach where a trained professional applies a controlled force to spinal joints. The goal is to alleviate pain and improve physical function by restoring the spine’s range of motion. This therapy is founded on the idea that correcting joint movement dysfunctions improves the body’s mechanical operation. It is a form of manual medicine used to address musculoskeletal issues.
The Spinal Manipulation Procedure
During a spinal manipulation session, a patient is positioned in a specific way to isolate the targeted spinal joint. The most common method used is the high-velocity, low-amplitude (HVLA) thrust, where the practitioner applies a quick and shallow impulse to the joint. This action is designed to move the joint slightly beyond its typical physiological range of motion without exceeding its anatomical limits. The force is carefully controlled and directed to a specific area.
A frequent occurrence during HVLA manipulation is an audible “pop” or “crack.” This sound, known as joint cavitation, is not the result of bones cracking but is caused by the rapid release of gas bubbles from the synovial fluid that lubricates the joints. The release of gasses like nitrogen and carbon dioxide reduces pressure within the joint capsule. The sound indicates joint surfaces have gapped, though it is not required for a successful mechanical effect.
While the HVLA thrust is widely used, it is not the only form of treatment. Practitioners may also use spinal mobilization techniques, which involve slower, more controlled movements rather than a quick thrust. These gentler methods are often preferred for patients who are uncomfortable with the popping sound. They are also used for those with sensitive nervous systems or specific medical conditions that make a thrust inadvisable.
Practitioners of Spinal Manipulation
Spinal manipulation is performed by several types of licensed healthcare professionals with specialized training. The primary practitioners include chiropractors, osteopathic physicians (DOs), and some physical therapists (PTs). Each profession incorporates spinal manipulation into their practice, though their philosophical approaches and treatment plans may differ.
Chiropractors are the most well-known practitioners, using spinal manipulation, or a “chiropractic adjustment,” as a central component of their treatment. Their training is focused on the musculoskeletal system, particularly the spine, and the use of adjustments to correct joint misalignments. Osteopathic physicians are medical doctors who receive specialized training in osteopathic manipulative treatment (OMT), which includes spinal manipulation.
Physical therapists may also be certified to perform spinal manipulation after completing extensive post-graduate training. For PTs, manipulation is one tool within a broader rehabilitation program that also includes exercise, education, and other modalities. A PT or DO typically integrates manipulation as part of a comprehensive strategy, whereas a chiropractor may focus on it as the primary intervention.
Conditions Treated with Spinal Manipulation
Spinal manipulation is applied to several musculoskeletal complaints, with varying levels of supporting evidence. The condition with the most substantial evidence is acute and subacute low back pain, where it can provide mild-to-moderate relief. Studies show it may be as effective as conventional care like exercise and pain medication, and it is often included in treatment guidelines for recent-onset low back pain.
The use of spinal manipulation for neck pain is also supported by evidence, as it can be effective for reducing pain and improving function. For some individuals, manipulation may offer short-term pain relief that is comparable to or better than other interventions. This makes it a common choice for those seeking alternatives to medication.
Spinal manipulation has also demonstrated effectiveness in managing cervicogenic headaches, which originate from musculoskeletal problems in the neck. Studies indicate that spinal manipulation can reduce the intensity and frequency of these headaches. Some research suggests it is more effective than mobilization or other physical therapy interventions for this condition, providing significant reductions in headache disability.
Safety and Contraindications
Spinal manipulation is considered safe when performed by a trained and licensed practitioner. The most common side effects are mild and temporary, resolving within 24 to 48 hours. These can include localized soreness, stiffness in the treated area, tiredness, or a temporary headache.
Rare but serious risks are associated with the procedure, particularly with manipulation of the cervical spine. The most significant is vertebral artery dissection (VAD), a tear in the wall of a neck artery that can lead to a stroke. While the statistical probability is very low, it is a known risk. Some research suggests the association may be due to patients with an existing dissection seeking care for neck pain and headache, which are also symptoms of VAD.
Certain medical conditions, known as contraindications, mean spinal manipulation should not be performed due to a high risk of harm. A thorough medical history and physical examination are necessary to screen for these conditions before treatment is initiated. Absolute contraindications include:
- Known spinal instability
- Severe osteoporosis
- Spinal cancer
- Acute fractures or dislocations of the spine
- Certain forms of inflammatory arthritis affecting the spine
- Recent spinal surgery